System and method for immediate health assessment response system

ABSTRACT

An immediate health assessment response system, comprising a testing device having thereon an alignment target and having a plurality of immunoassay test strips, the plurality of immunoassay test strips each including a sample pad capable of receiving a biologic sample, and a server configured to receive information from a mobile device regarding test results from a test performed using the testing device, receive an image from a mobile device, process the image to determine results based on pixel count and line intensity of the test line of each of the plurality of immunoassay test strips, compare the results of processing the image to a control for each test line of each of the plurality of immunoassay test strips, and provide a risk indicator, wherein the risk indicator alerts a user to seek medical attention immediately.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of U.S. patent application Ser. No.15/295,353, filed on Oct. 17, 2016, and entitled ARBOVIRUS INDICATIVEBIRTH DEFECT RISK TEST (Atty. Dkt. No. RIDL-33307). This applicationalso claims benefit of U.S. Provisional Patent Application Ser. No.62/409,089, filed on Oct. 17, 2016, and entitled SYSTEM AND METHOD FORIMMEDIATE HEALTH ASSESSMENT RESPONSE SYSTEM (Atty. Dkt. No. RIDL-33321).

TECHNICAL FIELD

The following disclosure is related to health alert systems and, morespecifically, to the home detection of medical conditions in conjunctionwith an alert system.

BACKGROUND

Home health test devices may only show that an individual has aparticular health condition, but not alert the individual that medicalattention should be sought. Therefore, what is needed is a system andmethod for home medical testing that also provides details on otherhealth conditions at a high rate of accuracy and to prompt test subjectto seek medical attention when test results warrant such.

SUMMARY

In one aspect thereof, an immediate health assessment response system isprovided. The system comprises a testing device having thereon analignment target and having a plurality of immunoassay test strips, theplurality of immunoassay test strips each including a sample pad capableof receiving a biologic sample, a conjugate pad containing particles forconjugating with antibodies or antigens present in the biologic sample,and a membrane strip having a test line and a control line, wherein thetest line and the control line are viewable, and a server configured toreceive information from a mobile device regarding test results from atest performed using the testing device, receive an image from a mobiledevice, process the image to determine results based on pixel count andline intensity of the test line of each of the plurality of immunoassaytest strips, compare the results of processing the image to a controlfor each test line of each of the plurality of immunoassay test strips,and provide a risk indicator, wherein the risk indicator alerts a userto seek medical attention immediately.

In another embodiment, the testing device is further configured to bindantigens or antibodies of an immune complex to antigens or antibodiesincluded on a control line of a membrane strip of the testing device.

In another embodiment, the control line serves as a control.

In another embodiment, the control is a dataset from previouslyconducted tests stored on a database and accessed by a softwareapplication.

In another embodiment, the test results include a qualitative result.

In another embodiment, the test results include a quantitative result.

In another embodiment, the quantitative result is a reaction rating.

In another embodiment, a test line of at least one of the plurality ofimmunoassay test strips includes an antibody suitable for binding withhCG.

In another embodiment, a test line of at least one of the plurality ofimmunoassay test strips includes Zika virus antigen.

In another embodiment, a test line of one of the plurality ofimmunoassay test strips includes Zika virus antigen and the test line ofanother one of the plurality of immunoassay test strips includes anantibody suitable for binding with hCG.

In another aspect thereof, a method for providing an immediate healthassessment response is provided. The method comprises receiving at aserver information from a mobile device regarding test results from atest performed using a testing device, a testing device having thereonan alignment target and having a plurality of immunoassay test strips,receiving at the server an image from the mobile device, processing atthe server the image, determining results based on pixel count and lineintensity of a test line of each of the plurality of immunoassay teststrips, comparing the results of processing the image to a control foreach test line of each of the plurality of immunoassay test strips, andproviding a risk indicator, wherein the risk indicator alerts a user toseek medical attention immediately.

In another embodiment, the method further comprises binding antigens orantibodies of an immune complex to antigens or antibodies included on acontrol line of a membrane strip.

In another embodiment, the control line serves as a control.

In another embodiment, the control is a dataset from previouslyconducted tests stored on a database and accessed by a softwareapplication.

In another embodiment, the test results include a qualitative result.

In another embodiment, the test results include a quantitative result.

In another embodiment, the quantitative result is a reaction rating.

In another embodiment, a test line of at least one of the plurality ofimmunoassay test strips includes an antibody suitable for binding withhCG.

In another embodiment, a test line of at least one of the plurality ofimmunoassay test strips includes Zika virus antigen.

In another embodiment, a test line of one of the plurality ofimmunoassay test strips includes Zika virus antigen and the test line ofanother one of the plurality of immunoassay test strips includes anantibody suitable for binding with hCG.

BRIEF DESCRIPTION OF THE DRAWINGS

For a more complete understanding, reference is now made to thefollowing description taken in conjunction with the accompanyingDrawings in which:

FIG. 1 illustrates a diagrammatic representation of one embodiment of aimmunoassay test strip;

FIG. 2 illustrates a diagrammatic representation of one embodiment of animmunoassay test wherein an analyte is tested across a plurality of teststrips;

FIG. 3 illustrates a diagrammatic representation of one embodiment of atesting device;

FIG. 4 illustrates a top view of the testing device of FIG. 3;

FIG. 5 illustrates a top view of one embodiment of a testing device;

FIG. 6 illustrates a top view of another embodiment of a testing device;

FIG. 7 illustrates a flowchart of one embodiment of a testing device usemethod;

FIG. 8A illustrates a diagrammatic representation of one embodiment of aprocess for a mobile device application for testing device image captureand image processing, wherein an image alignment indicator is notaligned with the subject of the image;

FIG. 8B illustrates a diagrammatic representation of one embodiment of aprocess for a mobile device application for testing device image captureand image processing, wherein an image alignment indicator is alignedwith the subject of the image;

FIG. 9 illustrates a flowchart of one embodiment of an image analysisprocess using a mobile device;

FIG. 10 illustrates a diagrammatic representation of another embodimentof a process for a mobile device application for testing device imagecapture and image processing, wherein an image alignment indicator isaligned with the subject of the image;

FIG. 11 illustrates one embodiment of a consumer driven biologic anddisease data collection system;

FIG. 12 illustrates one embodiment of a consumer driven biologic anddisease data collection system;

FIG. 13 illustrates an example of a unique biologic ID database table;

FIG. 14 illustrates a flowchart of one embodiment of a biologic datacollection and dissemination process;

FIG. 15 illustrates a perspective view of a system for scanning teststrips;

FIG. 16 illustrates a cross-sectional view of the system of FIG. 15;

FIG. 17 illustrates one embodiment of a vertical flow immunoassaydevice; and

FIG. 18 illustrates a cross-sectional view of one embodiment of thevertical immunoassay device of FIG. 17.

DETAILED DESCRIPTION

Referring now to the drawings, wherein like reference numbers are usedherein to designate like elements throughout, the various views andembodiments of an arbovirus indicative birth defect risk test areillustrated and described, and other possible embodiments are described.The figures are not necessarily drawn to scale, and in some instancesthe drawings have been exaggerated and/or simplified in places forillustrative purposes only. One of ordinary skill in the art willappreciate the many possible applications and variations based on thefollowing examples of possible embodiments.

Referring now to FIG. 1, there is illustrated one embodiment of animmunoassay test strip 100. The test strip 100 is typically housed in atesting device configured to collect a biologic analyte 106 from a userand to direct to the biologic analyte 106 onto the testing strip 100.However, it will be understood that the biologic may be applied onto astrip 100 without the strip 100 needing to be within a testing device.The test strip 100 includes a backing 102. The test strip 100 is made upof multiple sections disposed on the backing 102. A sample pad 104 isdisposed on one end of the strip 100, for collecting the biologicanalyte 106. The biologic analyte 106 may be any biologic needed for usein the immunoassay, such as urine, blood, saliva, stool, sweat, or otherbiologics to be used as an analyte. Various methods may be used toacquire the needed biologic, and such may be provided to the userpackaged with the test, such as swabs, vials, containers, dilutants andother solutions, or any other equipment required. In the case of a bloodanalyte, a few drops of blood may be obtained from a finger stick usinga finger prick device. Such a blood analyte may be blood mixed with anadequate amount of buffered solution to create the sample analyte 106 ora blood sample that is not diluted or otherwise manipulated, in whichcase the blood only is the analyte 106.

The biologic analyte 106, after coming into contact with the sample pad104, begins to migrate across the strip 100 by capillary action, cominginto contact with other sections of the strip 100. A particle conjugatepad 108 is disposed between the sample pad 104 and a test line 110. Theconjugate pad 108 may contain various reagents associated with aparticular antigen, such as a virus, allergen, or bacteria, the reagentsbeing items such antibodies, enzymes, or other reagents needed todiagnose the particular condition. The reagent in the conjugate pad 108may be conjugated with particles of materials such as colloid gold orcolored latex beads. As the analyte 106 migrates through the conjugatepad 108, antibodies present in the sample analyte 106 complex with thereagents in the conjugate pad 108, thereby creating an immune complexthat will migrate to the test zone or test line 110.

The test line 110 (T) may be precoated with the relevant antigen inquestion, i.e., a virus, allergen, or bacteria, for the detection ofantibodies associated with the particular antigen. The immune complexcreated when the analyte 106 passes through the conjugate pad 108 iscaptured onto the antigen contained on the test line 110. This maycreate a qualitative response on the strip where the test line 110 islocated, such as a colored response. In some embodiments, the test line110 may not be a line, but may be other shapes or symbols, such as aplus sign. If no antigen-anti-antigen complexes are present in theanalyte, no reaction occurs in the test line 110 and a qualitativeresponse will not occur.

After passing through the test line 110, the analyte migrates furtheralong the strip to reach a control line 112, where excessanti-antibody-colloidal gold or latex conjugates get bound. Aqualitative response may be shown at the control line 112, indicatingthat the sample has adequately migrated across the testing membrane orsubstrate as intended. It will be understood that the control line 112is not necessarily needed to perform the test, and may be eliminatedentirely, but the control line 112 does provide a comparative examplefor a user reading the test. For example, the control line 112, inembodiments where a colored qualitative response is provided, may appearas an overly saturated color, such as a dark or bright saturated red,once the sample reaches the control line 112. This saturated color maybe used as a comparison against the qualitative response shown on thetest line 110. For example, if the qualitative response shown on thetest line 110 is a much lighter red than that on the test line 110, itmay be that very little reaction occurred at the test line. Of course,if no response is shown at all at the test line 110, no reaction hasoccurred. If the qualitative response at the test line 110 is of asimilar saturation to the control line 112, a strong reaction isindicated.

The strip 100 may not be a continuous substrate. Rather, the varioussections of the strip 100 may be separate from each other, but alladhered to the backing 102. As shown in FIG. 1, the sample pad 104 andthe conjugate pad 108 are separate structures from each other. The testline 100 or zone and the control line 112 or zone are both disposed aspart of a nitrocellulose membrane strip 114. The nitrocellulose membranestrip 114 is also adhered to the backing 102, but separate from thesample pad 104 and the conjugate pad 106. As shown in FIG. 1, the end ofthe sample pad 104 adjacent to the conjugate pad 106 may overlap theconjugate pad 106, with that end of the sample pad 106 lying over theadjacent end of the conjugate pad 106. Similarly, the end of theconjugate pad adjacent to the nitrocellulose membrane strip 114 may lieover the end of the nitrocellulose membrane adjacent to the conjugatepad. This allows for the analyte 106 to be more easily deposited ontoeach section of the strip 100 as it migrates across the strip 100. Afterthe analyte 106 migrates across the nitrocellulose membrane strip 114,and thus across the test line 110 and the control line 112, the analyte106 comes into contact with a wick 116 for absorbtion and collection ofthe analyte 106. The end of the wick 116 adjacent to the nitrocellulosemembrane strip 114 may lie over that adjacent end of the nitrocellulosemembrane strip 114, as shown in FIG. 1.

Several Flow Immune Assays have been directed toward identifyingproteins, molecules of interest, and even immunoglobulins IgG, IgA, andIgM. IgE is an antibody (immunoglobulin E) that is normally present inthe blood freely circulating until it moves into the tissue where it isbound to mast cells through the receptor FcERI (F-C-epsilon-R-one)otherwise known as the high affinity IgE receptor. There is a smallamount of IgE bound to IgE receptors (high and low affinity receptors)on basophils, eosinophils, and other cells in the blood and tissues.

Many assay systems are geared toward the detection of infectiousproteins. All of the aforementioned tests use a non-humanantibody—usually IgG type—e.g., goat IgG antibody directed against aprotein of interest to detect the protein of interest from the sample(blood, urine, saliva, sweat, etc.). This antibody complexes withprotein of interest and forms a complex that travels across the membraneuntil it reaches the test zone. In the test zone there is an IgG typeantibody directed against IgG from that species of animal. As furtherdescribed herein, the present detecting apparatus and method use human(patient/consumer-derived) antibodies from the sample and the test zonethat contains a humanized antibody directed against the protein ofinterest that is preconjugated to a detecting substance that results ina visual change.

Summary of Target Antigen:

-   -   The target antigens may be proteins, glycoproteins, lipoproteins        or other molecular substances capable of eliciting an immune        reaction and/or being bound by human specific IgE (sIgE).

Immune Assay to Detect Specific IgE:

-   -   In the detecting apparatus and method of using the same, the        antigens are proteins conjugated to a noble metal, for example,        gold, or latex conjugated to antigen in the test zone, for the        purpose of detecting the presence of specific IgE (e.g.,        anti-peanut IgE in a blood sample from a finger prick). For        example, an IgG class antibody (IgG1, IgG2, IgG3, or IgG4) or        fragments of those classes of antibodies (fab fragments) whose        origin may be any animal species (goat, rat, human, etc.)        capable of detecting human IgE (anti-IgE IgG)—a suitable        commercially available humanized antibody, such as omaluzimab        may be used—may be used to form immune complexes of        IgG-anti-IgE-sIgE that will migrate to the test zone having        selected specific IgE that can bind to the conjugated antigen.

Immune Assay to Detect Total IgE (Not Concerned About Specific IgE):

-   -   Another embodiment includes using an IgG class antibody (IgG1,        IgG2, IgG3, or IgG4) or fragments of those classes of antibodies        (fab fragments) whose origin may be any animal species (goat,        rat, human, etc.) capable of detecting human IgE (anti-IgE        IgG)—a suitable commercially available humanized antibody that        is preconjugated to a detecting molecule that results in a color        change when bound to IgE as the target antigen in the test zone.

Referring now to FIG. 2, there is illustrated one embodiment of animmunoassay test 200 wherein an analyte 202 is tested across a pluralityof test strips 204. The plurality of test strips 204 may each beconfigured for testing for a particular antigen. For instance, one stripmay be for testing for the presence of streptococcal bacteria (strepthroat), one strip may be for testing for a peanut allergy, one stripmay be for testing for the Zika virus, etc. Additionally, each strip mayalso test for multiple antigens. For example, as shown in FIG. 2,multiple testing panels or lines maybe be incorporated. Each line may befor a particular antigen. As shown in FIG. 2, multiple test lines 206,208, and 208 may be disposed along the plurality of strips 204. A striptesting for allergens may have a panel for testing for peanut allergiesshown at test line 206 (CH1), for cat allergies shown at test line 208(CH2), or grass allergies shown at test line 210 (CH3).

Other examples of configurations for the testing panels can be, but arenot limited to: 1) Food 5: Peanut, milk, soy, wheat, egg; 2) Nut andseed panel: almond, cashew, hazelnut, peanut, pecan, walnut, sesameseed, sunflower seed; 3) seafood: crab, lobster, shrimp, salmon, tuna;4) Pets: cat, dog; 5) Indoor allergens: dust mites, mold mix(alternaria, aspergillus, penicillium, cladosporium), cat, dog; and 6)seasonal allergens: grass (Bermuda, bahia, Johnson, rye, timothy), trees(oak, elm, cedar, mesquite, pine, etc.), weeds (pigweed, ragweed, sage,Russian thistle).

With respect to other non-allergen antigens, the panels may be fortesting for strep, Zika, flu, anthrax, cold viruses, cancer, HPV, Lymedisease, mononucleosis (mono), and other illnesses, and/or otherconditions such as pregnancy (hCG detection) and disease risks. Someembodiments may allow for the testing of various arboviruses(arthropod-borne viruses). Arboviruses are viruses that are transmittedby arthropods, with mosquitos being a common vector for the virus.Vectors are organisms that transfer the virus from a host that carriesthe virus. Thus, in the case of mosquitos, a mosquito that feeds on ahost that is infected with a virus may infect others when that mosquitoagain feeds on an uninfected host. Well-known arboviruses include Denguevirus, Japanese encephalitis virus, Rift Valley fever virus, West Nilevirus, yellow fever virus, chikungunya, and Zika virus. Urine, blood,and saliva and other biologics may be used for arboviruses testing.

Certain antigens or medical conditions may be logically paired together.For instance, a testing device may include both a strip for detection ofpregnancy and a strip for the detection of the zika virus, as the Zikavirus has been known to cause birth defects in infants born to pregnantwomen that are infected with Zika. Thus, combining these two tests intoa single testing device or kit would alert a woman to a potential Zikainfection proximate in time to the time she also discovers she ispregnant, allowing the woman to seek medical attention immediately. Thisis a substantial improvement over past Zika testing, where a woman maybe required to wait weeks before results are returned from a lab afterhaving the biologic collected by her physician. In many cases, this maylead to a woman having passed a state-mandated cutoff point forabortions, such as 24 weeks in some states. Combining a Zika test with apregnancy test and physically linking the two tests, and thus allowingfor a woman to determine a Zika risk at the time of taking a pregnancytest, in which a pregnancy test may be taken as soon as six days afterconception, allows for that woman to take action much sooner than thestate mandated cutoff and waiting for lab results would allow.

Various testing devices that include the test strip 100 or strips may beused, such as a slide that supports the test strip 100, a cassette baseddiagnostic test, a dipstick, or combinations thereof. The test resultsin various embodiments may be in the form of a visual qualitativereading test, a visual semiquantitative format, a reader quantitativeassay format, and/or combinations thereof. Additionally, an electronicimplementation may be used where the result is displayed digitally on ascreen disposed within the apparatus, and visible to the user.

The apparatus and method of detection may be a “one-step” approach fromsample to reading without sample dilution or other sample manipulation.The sample may be diluted or endure other sample manipulation, forexample the blood sample is diluted with a buffer.

Referring now to FIG. 3, there is illustrated a diagrammaticrepresentation of one embodiment of a testing device 300. The testingdevice 300 includes a housing 302 that forms the body of the testingdevice. The housing 302 may be made of plastic, metal, or any materialdurable enough for shipping and subsequent handling by a user. Thehousing 302 may be hollow so that a plurality of test strips 304 may behoused within and so that a biologic may be deposited within the housing302. The testing device 300 may further have a plurality of windows 306,each window being associated with one of the plurality of test strips304, and allowing for a user to view at least the section of thenitrocellulose membrane strip 114 where the test line 110 and controlline 112 are located. The plurality of windows 306 may be open, orcovered with plastic, glass, or other materials that allow for viewingthe plurality of strips 304. A sample well 308 may be disposed on asurface of the housing 302 to allow a user to deposit a biologic intothe housing 302. The sample well 308 would be disposed over or near thesample pad 104 of the test strip or strips 100. In the embodiment shownin FIG. 3, a single sample well 308 is included for collection of asingle type of biologic for testing, with each of the plurality ofstrips 304 being suited for testing for antigens using that particularbiologic sample type. For example, if the testing device 300 is acombined pregnancy and Zika test, having both a pregnancy strip and aZika strip, a urine sample may be deposited into the sample well 308,causing the urine sample to come into contact with the sample pad 104 onboth the pregnancy strip and the Zika strip. It will be understood thatboth of these tests may also be performed with a blood sample.

The testing device 300 may also have disposed on the surface of thehousing a crosshair symbol 310, used as an alignment target. This symbolmay be a graphic printed or adhered to the testing device 300. Thecrosshair symbol 310 is used to align the testing device 300 for thetaking of an image of the testing device 300 using a camera on a mobiledevice, for use in a mobile device application described herein. Inother embodiments, the crosshair symbol 310 may be other types ofsymbols, such as a simple shape (circle, square, etc.), other images(such as a medical cross symbol, an arrow, etc.), or any other type ofimage.

Referring now to FIG. 4, there is illustrated a top view of the testingdevice 300. There is again shown the housing 302, the plurality of teststrips 304, the plurality of windows 306, the sample well 308, and thecrosshair symbol 310.

Referring now to FIG. 5, there is illustrated a top view of oneembodiment of a testing device 500. The testing device 500 includes ahousing 502 having a plurality of test strips 504 within the housing 502and a plurality of windows 506 for display of the plurality of strips504. The housing 502 also includes a plurality of sample wells 508disposed on one side of the testing device 500. Each of the plurality ofsample wells 508 is associated with one of the plurality of test strips504 and each of the plurality of sample wells 508 may be disposed overone of the sample pads 104 on the associated one of the plurality oftest strips 504. This allows for a biologic to be deposited into each ofthe plurality of sample wells 508, with each well 508 serving totransfer the biologic to the test strip underneath the sample well. Thetesting device 500 further includes a crosshair 510. The crosshairsymbol 510 is used to align the testing device 500 for the taking of animage of the testing device 500 using a camera on a mobile device, foruse in a mobile device application described herein.

Referring now to FIG. 6, there is illustrated a top view of anotherembodiment of a testing device 600. The testing device 600 includes ahousing 602 having a plurality of test strips 604 within the housing 602and a plurality of windows 606 for display of the plurality of strips604. The housing 602 also includes a plurality of sample wells 608. Inthis embodiment, the sample wells are located on different ends of thehousing 602. In the case of a two test strip device, the sample wells608 are disposed on opposite ends of the testing device 600. The strips604 would be arranged within the housing in such a way as to allow thesample pad 104 on each of the strip to be disposed underneath one of thesample wells 608. This is useful for testing devices that requiredifferent biological samples. For example, if the testing device 600required a urine sample for one strip and a blood sample for the otherstrip, having the wells 608 disposed on opposite sides of the testingdevice would reduce the likelihood that a urine sample, for instance,might be inadvertently deposited into the well designated for the bloodsample. In embodiments where there are more than two strips, and morethan two wells, the well positions may alternate between the two sidesof the testing device. For instance, a first well for a first stripmight be disposed on the left side of the testing device, a second wellfor a second strip might be disposed on the right side of the testingdevice, a third well for a third strip might be disposed on the leftside of the testing device, a fourth well for a fourth strip might bedisposed on the right side of the testing device, and so on. The testingdevice 600 further includes a crosshair 610. The crosshair symbol 610 isused to align the testing device 600 for the taking of an image of thetesting device 600 using a camera on a mobile device, for use in amobile device application described herein.

The diagnostic test can, for example, be produced in a various formatsfor different users, such as, but not limited to, consumer/in-home usewhere the test is purchased through retail channels which will allowindividuals to get an immediate, cost-effective test result that canlead to specific avoidance and treatment through follow-up with amedical professional.

The diagnostic test can be provided to and used by hospitals and clinicsto provide rapid, on-site test results that are required to prescribecertain medications, such as omaluzimab, by their FDA labels.

This diagnostic assay can be modified to detect the presence of specificIgE in pets.

It is also noted that housing 602 is designed such that both strips 604are disposed in physical proximity thereto and in the same actualhousing. In this manner, both sets are linked physically to each othersuch that they cannot be separated and can be associated with a singleindividual and the actual test cannot be separated. As such, when apatient applies the specimens to the two areas 608 and the test resultsare exhibited, there is a high probability that two tests were performedat the same time associated with the same patient. Additionally, andelectronic chip (not shown) can be embedded within the housing 602 suchthat the housing 602 can be registered to a specific patient andassociated with the medical records of that patient.

Referring now to FIG. 7, there is illustrated a flowchart of oneembodiment of a testing device use method 700. The method 700 begins atstep 702 where a biologic is collected in a sample well or wells of atesting device. The biologic collected may be a non-diluted ornon-manipulated biologic, such as blood, urine, or saliva from the userof the test. Diluted or manipulated biologics may be used instead, asrequired by the specific test. For example, if a viral test requires thebiologic to be added to a solution, the biologic could be added to asolution that has previously been placed in a sterilized vial providedwith the testing device. After the required amount of time has passed,the solution containing the biologic could be deposited into the well orwells. At step 704, the biologic contacts a sample pad disposed on astrip or strips within the testing device. At step 706, the biologicmigrates along the strip or strips to come into contact with a conjugatepad containing antibodies. Antibodies present in the biologic willcomplex with the antibodies in the conjugate pad to create an immunecomplex. At step 708, the biologic migrates into a test zone of thestrip or strips, coming into contact with an antigen. The antibodies inthe conjugate pad serve to provide a means of detection, such as acolored response, if the immune complex binds with the antigen presentin the test zone of the strip. At decision block 710, binding of theantibodies with the antigen may or may not occur depending on ifantibodies associated with the antigen are present in the biologic ornot. If a binding between the antibodies and the antigen does not occurthe process moves to step 712 where no qualitative response is producedon the test line. If a binding does occur, at step 714 a qualitativeresponse is produced on the test line. Whether a binding occurs or not,and whether a qualitative response is produced or not, the process movesto step 716 where the biologic migrates into a control zone of the stripor strips where excess conjugates get bound and produces a qualitativecontrol zone reaction indicating that the sample has adequately migratedacross the testing zone.

It will be understood by one skilled in the art that the antibodies andantigens applied to the testing strip may be altered depending on thetype of condition being tested. For example, in the case of testing formedical conditions that do not involve an illness or infection, likepreganancy, and thus the sample biologic does not contain antibodiesassociated with the condition, antibodies that react to markers beingtested for may be applied to the testing strip instead of an antigen.For instance, pregnancy test requires testing for the presence of hCG.Since hCG is a hormone and not an antibody produced in response to aninfection, the testing strip may have antibodies that will react to thepresence of hCG applied to the testing zone or line of the testingstrip, as well as to the conjugate pad. Similarly, some tests mightrequire antibodies be applied to the testing strip to detect antigenspresent in the sample, rather than antibodies.

Referring now to FIGS. 8A and 8B, there is illustrated a diagrammaticview of one embodiment of a process 800 for a mobile device applicationfor testing device image capture and image processing. The mobile deviceapplication allows for an image of a testing device, such as testingdevice 300, to be captured using a camera installed on a mobile device802 having a screen 804. While the mobile device 802 displays on thescreen 804 the scene captured by the camera, the mobile deviceapplication also displays a graphic on the screen 804 in the form of aboxed outline 806, the size of the outline 806 corresponding to the sizeof the testing device 300. Also displayed on the screen of the mobiledevice 802 within or near the outline is a crosshair graphic 808. A userof the mobile device 802 attempts to align the outline 806 with theborders of the testing device 300 and also attempts to align thecrosshair graphic 808 with the crosshair 310 on the testing device 300.While alignment has not yet been achieved, a misalignment warning 810may appear on the screen of the mobile device 802, indicating to theuser that alignment has not yet been achieved. Such is shown in FIG. 8A.

In FIG. 8B, there is shown the result of a successful alignment of theoutline 806 with the testing device 300 and successful alignment of thecrosshair graphic 808 with the crosshair 310 on the testing device 300.As shown in FIG. 8B, once aligned, a success indicator 812 may appear,such as a check mark or other positive status symbol, on the alignedimage. Successful alignment causes the camera on the mobile device 802to capture the current image of the testing device 300. Other checks mayoccur, including ensuring that the image is focused before the image issaved. This image is then processed to determine a result based on theseverity of the reaction occurring on the test strip. The mobile deviceapplication performs an analysis of the test line captured in the image,counting the number of colored pixels, as well as determining theintensity of the color. The mobile device may then compare this numberand color intensity to that in the control line, providing amathematical evaluation of the test line. Utilizing unique wavelengthsof light for illumination in conjunction with either CMOS or CCDdetection technology, a signal rich image is produced of the test linesto detect the colloid gold or latex particles. This provides anadvantage because a user simply looking at the two lines may not knowwhat the test line indicates, such as when the colored line does appearson the strip, but it is a faded line, rather than a dark line. Based onthis analysis, the mobile device application may provide a resultsindicator 814.

The results indicator 814 may be a qualitative result or a quantitativeresult. For example, and as shown in FIG. 8B, a qualitative result forthe results indicator 814 may indicate, in the case of a testing devicefor testing pregnancy as well as an infection, a plus sign next to aline reading “pregnant:” and a plus sign next to a line reading“infection:” to indicate that the user is both pregnant and infectedwith the bacteria or virus being tested, such as the Zika virus. For aquantitative result, the results might provide a numeric rating. Forinstance, a rating system between 1-100 may be used. If the resultsprovide a low rating to the user, such as a rating of 10, this indicatesa low risk of infection, although medical attention may be sought by theuser anyway. For example, if the user is pregnant, and also receives a10 rating for Zika, this may indicate that Zika was detected in lowamounts. However, the user may still seek medical attention or furthertesting from her doctor because Zika has been known to cause birthdefects. If the rating is a high rating, such as 95, this indicates thatan infection has most likely occurred and medical attention should besought immediately.

This same quantitative rating system may be applied to any test (viralinfections, bacterial infections, pregnancy, and other healthconditions), as the quantitative test can be performed using thesoftware described herein to accurately test bound antibodyconcentrations on the test strip. In some embodiments, a combinedqualitative and quantitative result may be presented, such as both arating and a plus or minus sign being presented, or other types ofquantitative and qualitative indications. Additionally, variouscombinations of tests may be provided for in the testing device, such aspregnancy/Zika, preganancy/flu, pregnancy/strep/Zika, etc.

Referring now to FIG. 9, there is illustrated a flowchart of oneembodiment of an image analysis process 900 using a mobile device. Atstep 902 a mobile device application is launched. At step 904 a cameraon the mobile device is activated and a crosshair indicator and atesting device outline appear on the mobile device screen. At step 906the crosshair indicator presented on the screen of the mobile device isaligned with a crosshair icon on the testing device and the deviceoutline presented on the screen of the mobile device is aligned with theborders of a testing device. At step 908, an indicator of successfulalignment is presented on the screen and an image of the testing deviceis taken by the mobile device camera. At step 910, the mobile deviceapplication processes the image of the testing device to determine testline strength by counting the number of colored pixels contained in thetest line. At step 912, the mobile device application correlates lineintensity with analyte concentrations to further determine test linestrength. At step 914, the mobile device application presents the testresults based on pixel count and line intensity, providing either aqualitative or quantitative result.

In some embodiments, the number of pixels indicating bound antibodies onthe strip may be measured against that in the control line to compareline intensity between the two lines, with the control line acting as anexample of a strong reaction, indicating a strong infection, anddetermining how close the test line intensity is to the control line.This would lead to a logical quantitative result. For instance, if thetest line is determined to have a pixel count and line intensity that is25% of the pixel count and line intensity of the control line, a ratingof 25 may be given. If a qualitative result is to be provided, a ratingof 25 may give a qualitative result that is negative, or it could bepositive depending on the type of condition being tested and knownactual infection results where a rating of 25 occurred for thatcondition.

In some embodiments, the test line may not be compared with the controlline to determine a result. Rather, the mobile device application mayhave access to a database having data on numerous past tests for thesame condition. This data may instead be used as the control. Thisallows the application on the mobile device to retrieve data on pasttests and compare the test line data of the current test to past tests.Overall data for past tests may be provided and compared against, suchas providing an average or a curve of past tests, or individual testsrated as having accurate results may be compared against.

In addition to a status result of an infection or other medicalcondition being provided to the user, other indicators of health mayalso be tested and results thereon provided. This provides for potentialearly identification of pregnancy and risk of morbidity, allowing formedical attention to be sought much more quickly. Indicators of healthmay be detected from biologics, such as urine and blood. Urine, forexample, allows for the detection of glucose levels, proteins, bacteria,and infectious markers. In the case of glucose, glucose is usually notfound in urine, but, if it is, that is an indicator of extremely highlevels of glucose in the body, where the kidneys release excess glucoseinto urine. This is often a sign of diabetes. Protein in the urine mayindicate a malfunctioning of the kidneys, which could be the result ofhigh blood pressure. Similarly, if blood is detected in urine, it couldbe a sign of a problem with the kidneys or the bladder. Blood, forexample, allows for the detection of glucose, inflammation, hormones,genetic defect risks, and metabolic endocrine disorders.

Referring now to FIG. 10, there is illustrated another embodiment of asuccessful alignment of the outline 806 with the testing device 300 andsuccessful alignment of the crosshair graphic 808 with the crosshair 310on the testing device 300, wherein quantitative results for health riskindicators are provided. In this embodiment, the results indicator 814provides a qualitative result for pregnancy, and quantitative resultsfor other health risk indicators. In the embodiment shown in FIG. 10,the health risk indicators being tested are markers for blood pressureand for glucose levels. For blood pressure, this is a test for markersin the blood that can be associated with high blood pressure. Thesecould be test for such things as low levels of vitamin D and the such.Studies have shown that patients suffering from essential hypertensionwill be under oxidative stress and Malondialdehyde (MDA) is theprincipal and most studied product of polyunsaturated fatty acidpre-oxidation. This can show an indirect correlation with anti-oxidants,particularly with superoxide dismutases (SODs) (r=0.573) and catalase(r=0.633) representative anti-oxidant are involved in reducing thestress of a patient's biological system during hypertension. Anothermarker for hypertension is buildup of uric acid, where in uric acid is amarker for xanthine oxidase-associated oxidants and that the lattercould be driving the hypertensive response. Additional markers arecortisol, a hormone. The test strips 604 can test for the differentbiological markers.

The results indicator 814 provides numeric ratings, in this case, 1-100,with the blood pressure rating being 88 and the glucose rating being 95.This indicates that both blood pressure and glucose are extremely high.Due to this, an additional alert indicator 1002 is presented to the useron the screen of the mobile device, alerting the user to seek medicalattention immediately. This is to ensure that the health of both thepregnant woman and the fetus can be checked as close to the time ofpregnancy detection as possible and medical attention received ifneeded.

Referring now to FIG. 11, there is provided a flowchart of oneembodiment of a pregnancy disease risk assessment process 1100. Theprocess 1100 begins at step 1102 where a biologic is collected anddeposited in a testing device for testing of the biologic. At step 1104,the biologic is processed by the testing device for detection ofpregnancy and various other medical conditions. These medical conditionsmay be high blood pressure, diabetes, bacterial or viral infections,inflammation, an increase in hormone levels, genetic disease markers,and/or metabolic disorders. At step 1106, a mobile device is used tocapture an image of the testing device after testing is complete. Insome embodiments, test results may be immediate. In other embodiments,and depending on the medical conditions being tested, the test may takea certain amount of time to complete. In this case, the user of the testwould be alerted to this fact in instructions provided with the testingdevice. Additionally, a visual indicator on the testing device may alertthe user that a test is now complete. At step 1108, the mobile deviceprovides a rating for each medical condition being tested, such as thatdescribed with respect to FIG. 10 herein.

At decision block 1110, it is determined whether the ratings for eachcondition exceed a certain threshold for that condition. If not, theprocess 1100 moves to step 1112, where an indication is presented to theuser via the mobile device screen that medical attention is notcurrently advised or necessary. If at step 1110 it is determined that atleast one of the medical conditions being tested rises above a certainthreshold, the process 1100 moves to step 1114 where a warning ispresented to the user via the mobile device screen that medicalattention is advised. The thresholds for medical conditions may nottrigger a warning even if a rating exceeds a threshold, if, in the eventof multiple tests being performed, the combined test results do notwarrant immediate medical attention. For example, if a user is testingfor a cold virus, blood pressure, and glucose, and only the cold virusrating is above the threshold, there may not be a warning provided tothe user. Additionally, ratings may be weighted or aggregated based onthe medical conditions being tested. For example, if blood pressure,inflammation, and glucose are being tested for, and they all are givenonly moderate ratings that do not rise above the threshold for anycondition individually, an warning to seek medical attention may stillbe provided due to the combination of conditions taken together.

Referring now to FIG. 12, there is illustrated one embodiment of aconsumer driven biologic and disease data collection system 1200. Datacollected from users performing the tests disclosed herein effectivelycan provide a wealth of information. As tests are performed data may bepassed by a plurality of mobile devices 1202 being used by usersperforming tests to a database 1204, the database being at a remoteserver 1206, over a network 1208. The user is sourcing a biologic fromuser's own body. This is done at home, not in a lab, hospital, orclinic. Each particular test would expect a certain type of biologic tobe provided. For instance, for a pregnancy test, a urine sample isprovided and tested for pregnancy markers. For a stool test, the stoolmight be dissolved in a vial with a solution provided with the testingdevice/kit, and tested for various disease or infectious markers. Dataand results from the tests may be stored on the database 1204 at theremote server 1206. As described herein, this data may be used as acontrol for testing analysis for users of the plurality of mobiledevices 1202. This data may also be used to provide data sets forbiologics to a medical organization 1210. The medical organization 1210may be doctor's offices, researchers, hospitals, testing labs, and otherindividuals or organizations that have an interest in the health andanalysis of users taking the test and of their biologic samples. In thisway, data can be gathered from a variety of biologics tested for avariety of different medical conditions and characteristics.

Referring now to FIG. 13, there is illustrated an example of a uniquebiologic ID database table 1300. The table 1300 is illustrative of thetype of data stored in association with data for a biologic transmittedby the plurality of mobile devices 1202 for storage on the database1204. A biologic ID header 1302 is provided that shows that the biologicsample has been given a unique ID. All data concerning the biologic maybe stored in association with the unique biologic ID. The table 1300also includes a biologic type entry 1304. This designates what type ofbiologic that the biologic associated with the unique ID is, such asblood, urine, stool, saliva, sweat, or other biologics. The table 1300also provides a plurality of test ratings 1304, for various testsperformed on the biologic. In the example shown in FIG. 13, a bloodbiologic is provided having an assigned ID of 2402, and having beentesting for pregnancy markers, the Zika virus, and for glucose levels.The rating for pregnancy was a 99 rating, the rating for a Zikainfection was a 75, and the rating for glucose levels was a 10. Thiswould indicate that the test subject has an extremely high likelihood ofboth a pregnancy and a Zika infection, which would have resulted in awarning to seek medical attention at the conclusion of the tests. Otherinformation may also be stored in the database in relation to thebiologic, including other condition ratings, time and date each test wasperformed, user information such as ethnicity, gender, and age, andstatus indicators such as whether a test subject visited a physician asa result of the tests. The database 1204 thus provides the test subjectwith a growing collection of information that may be accessed by thetest subject. This allows the test subject to present the test resultsto her physician for medical attention or additional testing, and allowsfor others who may access the database, such as disease researchers, tohave access to data on various biologic samples and their markers.

Referring now to FIG. 14, there is illustrated a flowchart of oneembodiment of a biologic data collection and dissemination process 1400.The process 1400 begins at step 1402 where a user of a testing devicecollects a biologic sample for use in a test or a series of tests. Atstep 1404, the test or series of tests are performed on the biologicsample. At step 1406, a mobile device application checks the biologicsample the testing device result to determine a quantitative result ofthe test to provide a correlative value for the condition being testedin the biologic sample. At step 1408, the test results and correlativevalues, or multiple values if multiple tests on the biologic sample wereconducted, are transmitted to the remote server 1206. At step 1410, thebiologic sample is given a unique identification number in the database1204. At step 1412, the test results and correlative value or values arestored in the database 1204 in association with the uniqueidentification number given to the biologic sample collected and inassociation with the particular tests performed. This way, theparticular biologic sample may have various characteristics stored andretrieved in association with the biologic sample, and the test resultsmay also be retrieved when data on a particular test is needed on across-section of users.

At step 1414, the results are provided to the user on the user's mobiledevice. At step 1416, the results are provided to the user's healthcareprovider. The healthcare provider may receive the test results due to avisit from the user, the user bringing the results of the test with heron her mobile device, or the healthcare provider may receive the resultsfrom the database 1204 if the healthcare provider has permission toaccess the database 1204, or if access is granted in anticipation of theuser's appointment with the healthcare provider. At step 1418, the testresults are also provided to other healthcare industry individuals andorganizations, including medical researchers, hospitals, and others.

Referring now to FIG. 15, there is illustrated a perspective view of asystem for scanning test strips. The housing 604, as describedhereinabove with respect to FIG. 6, is illustrated as being disposedwithin a slot 1502 in a test housing 1504. The test housing 1504 isconnected through a line 1506 to a PC 1508. When the housing 604containing the test strips 604 after being subjected to the biologics isinserted within the slot 1502, the test housing 1504 will scan the teststrips 604 and analyze the results with the PC 1508. The PC 1508 willrun some type of algorithm that can analyze the results of both of thetest strips 604. There can be provided to indicators 1510 and 1512 onthe surface of the test housing 1504, one being, for example, a readyLED and one being a green LED. The PC 1508, after analyzing results, canthen provide a warning indicator such as lighting up the green LED for apositive indication of pregnancy and the red LED for indicating thatthere is some issue. As an example, suppose that the second test striptested for the Zika virus. If so, a warning would be appropriate tooutput and activate the red LED. There could be any other type ofindicator associated with the second test at 604 that, in a combinationwith the test results of the first test strip, i.e. for testing for thepresence of a pregnancy state, testing for such things as diabetes, etc.Further, although only two test strips 604 are illustrated, there couldbe multiple test strips testing for many different biological issuesthat may be present in an individual. In this embodiment, by insertingthe housing 602 into the test housing 1504 and allowing the PC 1508 toanalyze the results, the indicators associated with the test strips canbe analyzed with the assumption that all of the test return results wereassociated with an individual and in proximate time to each other. Thatmeans that the individual patient applied biological specimens, such asurine, blood, etc., to the appropriate test strips and, since these wereall contained within the same test strip housing 602, this provides anindication that they are associated with a single patient. Further, thetest performed will typically be a test that will provide a veryshort-term response. Thus, the specimens can be applied to the teststrips 604 in the test strip housing 602 and then inserted within theslot 1502 for testing by the PC 1508.

Referring now to FIG. 16, there is illustrated a cross-section of thetest housing 1504. It can be seen that the test strip housing 1602 ispassed in slot 1502 past the camera 1602. The camera 1602 is operable toscan a small cross-section of the test strips 604 on the surface thereofas the test strip housing 602 passes thereby. Of course, there couldalso be a much larger camera provided for taking an entire image of thetest strips 604 after being inserted within the test housing 1504. Thecamera 1602 is connected via a wire 1604 two in electronics package 1606to process the information and send it to the PC 1508. The electronicspackage 1606 will also drive the indicators 1510 and 1512.

Referring now to FIG. 17, there is illustrated one embodiment of avertical flow immunoassay device 1700. It will be understood thattesting device 300 and other embodiments herein illustrate a lateralflow immunoassay device. However, other types of immunoassay devices maybe used. For example, vertical flow immunoassay devices may be used, atwo-sided flow through assay, or even a sandwich ELISA test may be run.

The testing device 1700 includes a housing 1702 that forms the body ofthe testing device. The housing 1702 may be made of plastic, metal, orany material durable enough for shipping and subsequent handling by auser. The housing 1702 may be hollow so that a plurality of immunoassaytest pads 1704 may be housed within and so that a biologic may bedeposited within the housing 1702. The testing device 1700 may furtherhave a plurality of sample wells 1706, each sample well having one ofthe plurality of immunoassay test pads 1704 disposed within, andallowing for a user to view at least a section of a nitrocellulosemembrane of each of the immunoassay test pads 1704, the membrane 1708having a test line 1708 and control line 1710. The testing device 1700may also have disposed on the surface of the housing a crosshair symbol1712, used as an alignment target. This symbol may be a graphic printedor adhered to the testing device 1700. The crosshair symbol 1712 is usedto align the testing device 1700 for the taking of an image of thetesting device 1700 using a camera on a mobile device, for use in amobile device application described herein. In other embodiments, thecrosshair symbol 1712 may be other types of symbols, such as a simpleshape (circle, square, etc.), other images (such as a medical crosssymbol, an arrow, etc.), or any other type of image. In otherembodiments, the device 1700 may be configured in such a way as to allowa biologic sample to be deposited into a sample well, and to present theresults of the test on the opposite side of the housing. Such aconfiguration would allow the biologic to flow through the testing padwithin the housing, with the reaction occurring on a reactive membraneon the side of the device opposite the sample well, with the devicehaving a window for viewing the results.

Referring now to FIG. 18, there is illustrated a cross-sectional view ofone embodiment of the vertical immunoassay device 1700. There is shownone of the plurality of immunoassay test pads 1704 residing within thehousing 1702 below one of the plurality of sample wells 1706. The one ofthe plurality of immunoassay test pads 1704 includes a immunoreactivemembrane 1802, such as the nitrocellulose membranes disclosed herein.The immunoreactive membrane 1802 may have particle conjugates disposedthereon that binds when a biologic sample is received onto theimmunoreactive membrane 1802 via the sample well 1706, if the biologicsample contains the antigens or antibodies, or other indicators, forwhich the test is configured. The one of the plurality of immunoassaytest pads 1704 also includes an absorbent pad 1804 for collection ofexcess biologic sample. It will be understood that the cross-sectionalview illustrated in FIG. 18 shows one well of the plurality of samplewells 1704. The other wells included in the device 1700 would beconfigured in a similar manner as that shown in FIG. 18. There may alsobe included in the device 1700 an inner separating wall between each ofthe plurality of immunoassay test pads 1704, to ensure that excessbiologic material that is not adequately absorbed by the absorbent pad1804 does not contaminate neighboring immunoassay test pads.

It should be understood that the drawings and detailed descriptionherein are to be regarded in an illustrative rather than a restrictivemanner, and are not intended to be limiting to the particular forms andexamples disclosed. On the contrary, included are any furthermodifications, changes, rearrangements, substitutions, alternatives,design choices, and embodiments apparent to those of ordinary skill inthe art, without departing from the spirit and scope hereof, as definedby the following claims. Thus, it is intended that the following claimsbe interpreted to embrace all such further modifications, changes,rearrangements, substitutions, alternatives, design choices, andembodiments.

What is claimed is:
 1. An immediate health assessment response system,comprising: a testing device having thereon an alignment target andhaving a plurality of immunoassay test strips, the plurality ofimmunoassay test strips each including: a sample pad capable ofreceiving a biologic sample; a conjugate pad containing particles forconjugating with antibodies or antigens present in the biologic sample;and a membrane strip having a test line and a control line, wherein thetest line and the control line are viewable; and a server configured to:receive information from a mobile device regarding test results from atest performed using the testing device; receive an image from a mobiledevice; process the image to determine results based on pixel count andline intensity of the test line of each of the plurality of immunoassaytest strips; compare the results of processing the image to a controlfor each test line of each of the plurality of immunoassay test strips;and provide a risk indicator, wherein the risk indicator alerts a userto seek medical attention immediately.
 2. The immediate healthassessment response system of claim 1, wherein the testing device isfurther configured to bind antigens or antibodies of an immune complexto antigens or antibodies included on a control line of a membrane stripof the testing device.
 3. The immediate health assessment responsesystem of claim 2, wherein the control line serves as a control.
 4. Theimmediate health assessment response system of claim 3, wherein thecontrol is a dataset from previously conducted tests stored on adatabase and accessed by a software application.
 5. The immediate healthassessment response system of claim 1, wherein the test results includea qualitative result.
 6. The immediate health assessment response systemof claim 1, wherein the test results include a quantitative result. 7.The immediate health assessment response system of claim 6, wherein thequantitative result is a reaction rating.
 8. The immediate healthassessment response system of claim 1, wherein a test line of at leastone of the plurality of immunoassay test strips includes an antibodysuitable for binding with hCG.
 9. The immediate health assessmentresponse system of claim 1, wherein a test line of at least one of theplurality of immunoassay test strips includes Zika virus antigen. 10.The immediate health assessment response system of claim 1, wherein atest line of one of the plurality of immunoassay test strips includesZika virus antigen and the test line of another one of the plurality ofimmunoassay test strips includes an antibody suitable for binding withhCG.
 11. A method for providing an immediate health assessment response,comprising: receiving at a server information from a mobile deviceregarding test results from a test performed using a testing device, atesting device having thereon an alignment target and having a pluralityof immunoassay test strips; receiving at the server an image from themobile device; processing at the server the image; determining resultsbased on pixel count and line intensity of a test line of each of theplurality of immunoassay test strips; comparing the results ofprocessing the image to a control for each test line of each of theplurality of immunoassay test strips; and providing a risk indicator,wherein the risk indicator alerts a user to seek medical attentionimmediately.
 12. The method of claim 11, further comprising bindingantigens or antibodies of an immune complex to antigens or antibodiesincluded on a control line of a membrane strip.
 13. The method of claim12, wherein the control line serves as a control.
 14. The method ofclaim 13, wherein the control is a dataset from previously conductedtests stored on a database and accessed by a software application. 15.The method of claim 11, wherein the test results include a qualitativeresult.
 16. The method of claim 11, wherein the test results include aquantitative result.
 17. The method of claim 16, wherein thequantitative result is a reaction rating.
 18. The method of claim 11,wherein a test line of at least one of the plurality of immunoassay teststrips includes an antibody suitable for binding with hCG.
 19. Themethod of claim 11, wherein a test line of at least one of the pluralityof immunoassay test strips includes Zika virus antigen.
 20. The methodof claim 11, wherein a test line of one of the plurality of immunoassaytest strips includes Zika virus antigen and the test line of another oneof the plurality of immunoassay test strips includes an antibodysuitable for binding with hCG.